P - 79818REQUEST FOR ELECTRICAL INSPECTION
1 2 3 2 6 4 2 Minnesota Board of Electricity
i � 1821 University Avenue Suite S-128, Saint Paul, Minnesota 55104
°� ' (651) 642-0800 TTY/MRS 1-500-627-3529
www. electricity. state. mn. us
IdentiTy the work covered by this request:
❑ NEW REMODEL ❑ADDITION ❑ REPAIR � QL�Y7
GENERAL FEES Outdoor Li htin Standard �$1
SERVICES / POWER SUPPLIES Traffic Si nal Standard �$5
0 to 400 Am ere �$25 Su plemental Fee �$20
401 to 800 Am ere �$50 Transformers u to 10 KVA �$10
Above 800 Am re �$75 Transformers overl0 KVA (� $20
CIRCUITS 1 FEEDERS Transformer I Power Su pl for Si ns / Outline Li htin �$5
0 to 200 Am ere �$5 ONE & TWO FAMILY DWELLINGS, EACH UNIT
Above 200 Am re �$10 Includes the Service andlor Power Supply up to 500 Amperes, All
ALARM, COMMUNICATION, REMOTE CONTROL, SIGNALING Circuits and Two Ins ection Trips Each Dwellin Unit (� $SO
CIRCUITS, CIRCUITS OF LESS THAN 50 VOLTS Addftional Ins ection Tri s�$20
Each S stem Device or ratus �$.50 Investi ative Fee
ADDITIONS TO THE GENERAL FEES Reins ion Fee �$20
MULTIFAMILY DWELLINGS PER UNI TOTAL FEE �—e.
3 to t2 Units �$5o Per Unit (minimum total fee is $20)
Each Additi0r111 Unit �$25 FOR INSPECTOR USE ONLV
OTHER ADDITIONAL FEES
Li hti� Retrofit �$25 r Fbcture
Center Pivot Irci tion Boom �$40
Manufactured Hame Park Lots fd $25 � I hereby ' that I inspeded the elechical inslaNalion described herein on the dates ststed:
Recreational Vehide Park Sites (� $5 "01C�'" °"'�
S arate Bondi Ins ction �$20
S 'al Ins ection �$30 er Hour F""""��"01 °"'�
S ecial Ins ection �$.31 er Mile �l`'—�° � Z� �,
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS
FOR OFfICE USE ONIY
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Request Date: Rough-in Inspection Required7 ❑ Yes No Inspection Other Than Rou h-In: ❑ Ready Now VYIB Call
� L �� You must call the inspector when ready! Date Ready: �� (/�
I certify that I am the LICENSED CONTRACTOR ❑ COMPANY ❑ OWNER and hereby request inspection of the electrical work at:
Job Address (SVeet, Box, or Route No.) Ciry 2ip Code
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Section Township Range Fire No. County
Occupant Phone � � � � �
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Power Supplier
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Mailin Address
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Authorized Si
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BOARD OF ELEC'�p�C�7ry
Master License Number
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INSTRUCIWNS ON BACK OF YELLOW COPY